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Complex Fibromyalgia Diagnosis

Factors Complicating Fibromyalgia Diagnosis

woman-headacheFibromyalgia is one of the most poorly diagnosed rheumatic conditions, despite it being fairly common. The diagnostic process is both frustrating and difficult for patients and physicians alike. In our latest blog, we attempt to uncover why this is the case.

General lack of knowledge and understanding

Most patients facing chronic widespread pain and other symptoms related to fibromyalgia tend to visit their GP for guidance, which often involves a lengthy and complex diagnostic process. A study published in the US National Library of Medicine assessed the awareness and knowledge of diagnostic and clinical features of fibromyalgia amongst GPs. 96% of the 172 participants claimed to be familiar with fibromyalgia; however, the findings suggest otherwise with only 55% aware fibromyalgia is associated with widespread pain.

Criteria for diagnosing

There isn’t a clear path to diagnosing fibromyalgia, however, many doctors use a benchmark, set in 2010 by the American College of Rheumatology (ACR), to identify the illness. These guidelines state, a patient with fibromyalgia must display signs of both the below points:

  • Constant pain in all four quadrants of the body (left and right sides, above and below the waist) for at least three consecutive months

This criteria has been criticised in the medical community for not taking into account the disease’s behaviour. Fibromyalgia has over 200 symptoms that vary in intensity, so a person that meets the criteria at one point may not in a few hours or days. This diagnostic formula also neglects symptoms unrelated to pain, such as fatigue and depression.

No defined tests to pinpoint fibromyalgia   

A doctor examining for fibromyalgia will ask the patient questions relating to their symptoms and medical history, as well as conduct a physical examination. If fibromyalgia is being considered, the medical team will usually take further effort to rule out all other possibilities, with tests involving blood, urine, x-rays and other scans. This complicated and lengthy process usually compels the patient to also seek out medical care from specialists as listed below:

  • Rheumatologists
  • Pain Specialists
  • Neurologists
  • Orthopaedists
  • Psychologists

Undiagnosed/ Misdiagnosed

The windy and unclear path to determining fibromyalgia results in many people left undiagnosed, and forced to live with the illness without any understanding of the cause of their pain or treatments available to them to alleviate symptoms. A multicenter study on misdiagnosis in fibromyalgia analysed 427 consecutive outpatients (418 females and 9 males; mean age of 49.3). All patients, with a previous or new fibromyalgia diagnosis, were complaining of chronic widespread pain. The study reports, 57 patients (13.3%) had been referred with an incorrect diagnosis, reaffirming how it can be a challenge for GPs and specialists to differentiate  fibromyalgia from various other rheumatic and musculoskeletal disorders.

Coexisting Conditions  

It’s also common for fibromyalgia patients to have coexisting conditions that share symptoms, like chronic widespread pain, making it even more difficult for medical professionals to reach a full diagnosis. Often physicians, especially those unfamiliar with fibromyalgia, may limit themselves by treating one illness and neglect to check if fibromyalgia could also be contributing to the patient’s overall discomfort. Find out more about disorders that tend to accompany fibromyalgia here.

As detailed above, the substantial time and financial burden attached to the complex diagnostic process for fibromyalgia, is frustrating for patients. If sufferers are more in tune with their condition it will help them report it to their physician more accurately. It’s a good idea to log your symptoms, as they occur, in a journal and involve your family or friends, in case they spot indicators you don’t. If you’ve been diagnosed with fibromyalgia, we want to hear about the process that led to it, get in touch through social media on Facebook or Twitter or send us an e-mail to:

We do not endorse any research, studies or sources mentioned within our blogs and comments. Furthermore, we do not endorse any medical advice provided, and would strongly recommend anyone seeking medical advice to contact their local healthcare provider.


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